New York City

1 New york city Summary Program Description (SPD). health benefits Program The city of New york Office of Labor Relations Employee benefits Program health benefits Program TABLE OF CONTENTS. Table of Contents .. 1. The city of New york 's health benefits Program .. 4. Introduction .. 4. Choosing a health Plan .. 4. Section I What Employees Need to Know .. 5. Enrollment .. 6. Waiver of health benefits .. 7. Pre-Tax benefits Program .. 7. Effective Dates of Coverage .. 8. For Employees .. 8. For Eligible Dependents .. 8. health Plan Premiums .. 8. Optional Riders .. 8. Changes in Enrollment Status .. 9. Changes in Family Status - Adding or Dropping Dependents .. 9. health Benefit Changes .. 9. Leave of Absence Coverage .. 9. Family and Medical Leave Act (FMLA) .. 9.

2 Special Leave of Absence Coverage (SLOAC) .. 9. Transfer from One city Agency to Another .. 10. Change of Union or Welfare Fund Membership .. 10. Termination and 10. Options Available When city Coverage 11. Special Continuation of Coverage Under NYS Chapter Law 436 .. 11. Special Provisions for Medicare-Eligible Employees .. 11. Section II What Retirees Need to Know .. 13. Enrollment .. 14. Effective Dates of Coverage .. 16. For Retirees .. 16. For Eligible Dependents .. 16. health Plan Premiums .. 16. Changes in Enrollment Status .. 17. Changes in Family Status - Adding or Dropping Dependents .. 17. 1|P a g e health Benefit Changes .. 17. Termination and 17. Options Available When city Coverage Terminates .. 18. Special Continuation of Coverage under NYS Chapter Law 436.

3 18. city Coverage for Medicare-Eligible Retirees .. 18. Medicare Enrollment .. 19. Medicare and Retiring Employees .. 19. Medicare Part B Reimbursement .. 19. Section III - COBRA .. 20. COBRA Eligibility .. 20. COBRA Periods of Continuation for Dependents .. 20. COBRA Notification Responsibilities .. 21. Election of COBRA Continuation .. 21. COBRA Transfer Opportunities .. 21. SECTION IV Disability benefits .. 22. SECTION V - Coordination of benefits (COB) .. 22. Section VI - Transgender Inclusive health benefits Coverage .. 22. What's Covered, Other Services? (Affirmatively covering transgender-related services, as with other services.) .. 22. SECTION VII Summary of health Plans .. 24. Glossary of Important Terms .. 25. health Plans & PICA Program for Employees and non-Medicare Retirees.

4 27. Aetna EPO .. 28. Cigna .. 30. DC 37 Med-Team .. 32. Empire EPO .. 35. Empire HMO .. 38. GHI-Comprehensive benefits Plan/Empire BlueCross BlueShield Hospital Plan (GHI-CBP) .. 40. GHI 45. HIP HMO .. 47. HIP Prime POS .. 50. MetroPlus Gold .. 53. Vytra health Plans .. 55. PICA Program .. 58. health Plans for Medicare-Eligible Retirees and Their Medicare-Eligible Dependents .. 61. Important Information about health Plan Enrollment and Disenrollment .. 61. Medicare Supplemental 62. Medicare HMOs & Medicare Advantage Plans .. 62. Medicare Coordination of Benefit Plans .. 62. 2|P a g e DC 37 Med-Team Senior Care .. 63. Empire Medicare-Related Coverage .. 64. GHI/EBCBS Senior Care .. 65. Aetna Medicare Advantage Plan (PPO) and Aetna Medicare Advantage Plan with an Extended Service Area (ESA).

5 66. Elderplan .. 68. Empire MediBlue HMO .. 69. VIP Premier (HMO) Medicare (formerly HIP VIP Medicare) .. 71. United HealthCare Group Medicare Advantage Plan .. 72. AvMed Medicare Choice HMO .. 73. BlueCross BlueShield of Florida health Options - Medicare & More (Florida Residents) .. 74. Cigna-Healthspring (Arizona Only) .. 75. Humana Gold Plus .. 76. GHI HMO Medicare Senior Supplement .. 77. SECTION VIII The city of New york 's Employee Assistance programs .. 78. SECTION IX The Employee Blood Program .. 79. Current as of January 2018. 3|P a g e THE city OF NEW york 'S health benefits PROGRAM. INTRODUCTION. Through collective bargaining agreements, the city of New york and the Municipal Unions have cooperated in choosing health plans and designing the benefits for the city 's health benefits Program.

6 These benefits are intended to provide you with the fullest possible protection that can be purchased with the available funding. This Summary Program Description (SPD) provides you with information about your benefits under the New york city health benefits Program. CHOOSING A health PLAN. Contact the health plans in which you are interested for benefits packages and provider directories. Telephone numbers, addresses and web sites are listed at the beginning of each plan description. To select a health plan that best meets your needs, you should consider at least four factors: Coverage - The services covered by the plans differ. For example, some provide preventive services while others do not cover them at all; some plans cover routine podiatric (foot) care, while others do not.

7 Choice of Doctor - Some plans provide partial reimbursement when non-participating providers are used. Other plans only pay for, or allow the use of, participating providers. Convenience of Access - Certain plans may have participating providers or centers that are more convenient to your home or workplace. You should consider the location of physicians' offices and hospital affiliations. Cost - There is no cost for basic coverage under some of the health plans offered through the city health benefits Program, but others require a payroll deduction. Additional benefits ( , prescription drug coverage) may be available through an Optional Rider. These costs are compared on the rates charts which are available on the health benefits Program Web site at Some plans require copayments for certain services.

8 Some plans require you to pay a yearly deductible and coinsurance before the plans will reimburse you for the use of non-participating providers. If a plan does not cover certain types of services that you expect to use, you must also consider the out-of-pocket cost of these services. The plan you have chosen will send you information regarding your health benefits coverage when you enroll. NOTE - DOUBLE city COVERAGE PROHIBITED. If a person is eligible for the city program as both an employee/retiree or a dependent, the person must choose one status or the other. No person can be covered by two city health contracts at the same time. Eligible dependent children must all be enrolled as dependents of one parent. If either spouses or domestic partners are eligible and one is enrolled as the dependent of the other, the dependent may pick up coverage in his or her own name if the other's contract is terminated.

9 4|P a g e SECTION I WHAT EMPLOYEES NEED TO KNOW. YOUR RESPONSIBILITIES. It is important that you know how your health plan works and what is required of you. Here are some important things that you need to remember: Complete an enrollment form to add new dependents (newborn, adoption, marriage) within 30 days after the event;. Notify your agency and your health plan in writing when your address changes;. Review your payroll check to ensure appropriate premiums are deducted;. Know your rights and responsibilities under COBRA continuation coverage. IF YOU NEED ASSISTANCE. Contact your agency health benefits or payroll office or NYCAPS Central at (212) 487-0500. Department of Education employees should contact HR Connect at (718) 935-4000. For questions concerning eligibility and enrollment, including changes in family status other than domestic partnership issues For questions regarding deductions for health benefits For Transfer Period information To obtain a health benefits Application To obtain information and an application for COBRA benefits To change your address If health coverage has been terminated for you and/or your dependents Employees with access to Employee Self Service (ESS) through CityShare can check their coverage status and make changes.

10 WHEN SHOULD I CONTACT MY health PLAN? If you have questions regarding covered services To obtain written information about covered services For information about the status of pending claims or claim disputes For claim allowances (How much will a plan pay towards a claim?). For health plan service areas When writing to a health plan, include your name and address, certificate number, date(s) of service, and claim number(s), if applicable. Some plans also allow inquiries through their web sites. (Refer to your health plan identification card or plan booklet for telephone numbers.). WHEN SHOULD I CONTACT MY UNION/WELFARE FUND? For information about: Prescription drug coverage (if applicable). Vision benefits Dental benefits Life Insurance (if applicable). WHEN SHOULD I, AS AN ACTIVE EMPLOYEE, CONTACT THE health benefits PROGRAM?